Each January, millions of Medicare Advantage (Part C) enrollees have their first opportunity to experience health care under their 2019 plans. Many Medicare recipients love their plans, but some discover what they signed up for isn’t covering their needs.
Thankfully, The Centers for Medicare and Medicaid Services (CMS) give folks the chance to change up their coverage. You can do this during the Medicare Advantage Open Enrollment period, known as OEP.
OEP will run from January 1 through March 31 each year. During this time, people already enrolled in Medicare Advantage can switch to a different Medicare Advantage (MA) plan. Or they can go back to Original Medicare and Part D.
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If you’re not sure which option is best for you, compare Original Medicare vs. Medicare Advantage plans before deciding.
OEP is a new enrollment period beginning in 2019 that replaces the old Medicare Advantage Disenrollment period. It’s different from the fall Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year.
OEP and AEP differ in several ways, which we’ll get into in a moment. The biggest difference, however, is OEP is only for people who are enrolled in a Medicare Advantage plan as of January 1.
If you have Original Medicare (Parts A and B), which is also sometimes called traditional Medicare, this enrollment period isn’t for you. But don’t worry. We’ll let you know what to do in that case, too.
Changing plans during OEP 2019
Are you happy with your Medicare Advantage coverage? If not, Medicare Advantage Open Enrollment is the perfect time to change that by changing plans. But before you create a game plan to maximize OEP, understanding how your current plan may change moving forward can be helpful.
Annually, Medicare policies can change costs, health coverage, in-network providers, pharmacies, and more. That’s where an Annual Notice of Change comes in.
Annual Notice of Change
Medicare requires your current plan to send you an Annual Notice of Change (ANOC) by September 30. This document outlines all changes going into effect January 1 of the following year.
Generally, we recommend carefully looking over your ANOC as soon as possible. Doing so will help guide you during AEP starting October 15.
That said, weather changes, the holidays, and wrapping up the year all make fall a busy time of year. Checking to see what might change next year may not be top of mind, and AEP might have blown right past you.
That’s okay. Having a second chance to make changes to your coverage is what OEP is all about.
If you still have your ANOC in a drawer somewhere, look it over now to help you decide whether to keep your current plan or change things up. If you’ve misplaced your ANOC, don’t be afraid to call up your insurance company and ask for another one. This is important stuff.
OEP may be your final opportunity to change your Medicare coverage for 2019, so make sure you’re prepared.
Other 2019 Medicare changes
The new Medicare Advantage Open Enrollment Period is one of the more significant changes CMS made to Medicare in 2019.
The Medicare program typically releases a comprehensive list of these changes for the following year in April, but these documents are often hundreds of pages long. To help get you ready for OEP, we’ve included the highlights in our 2019 Medicare Advantage Plan Changes article.
Changing plans: switching Medicare Advantage plans
There are thousands1 of Medicare Advantage plans out there, and they vary widely by both cost and coverage. Medicare beneficiaries who have an Advantage plan and want to continue in that vein might shop around for new plans during OEP for several reasons.
Your current plan has changed or stopped
Because private companies run individual Medicare Advantage plans, these plans tend to change more frequently than Original Medicare. Insurers may even make some changes throughout the year, such as covering different prescription drugs or altering their service area. If you’re not happy with these changes, use OEP to find a better option.
Your situation has changed
Just as many MA plans don’t stand still for long, your life doesn’t either. Changes in lifestyle, health, and medications could mean your current plan isn’t your best option anymore. Open Enrollment gives you the chance to find a plan that’s better suited to the new you.
You want a better deal
Some consumers who are completely happy with their current Advantage plan make a habit of shopping around for better plans whenever they can anyway. Doing so ensures they always get great health coverage for the best price.
If you rushed into choosing your current Medicare Advantage plan, OEP lets you check out more options and make a switch.
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Changing plans: Medicare Advantage to Original Medicare
Medicare Advantage plans are a solid one-stop shop for health insurance, but they may come with additional costs, both financial and otherwise. Some people use their Open Enrollment Period to go back to Original Medicare for the following reasons:
If you expect to have a lower income or fewer medical needs next year, it may make sense to change plans. Parts A and B combined may have lower premiums than the most comprehensive Medicare Advantage plans do. Calculate costs carefully, however, because Original Medicare usually also offers less coverage, and you may have higher out-of-pocket expenses.
You may also need to enroll in Part D prescription drug coverage, which will require an additional monthly premium. Skipping Medicare prescription drug coverage could result in a Late Enrollment Penalty added to Part D premiums in the future if you later decide you do want this coverage.
If you’re struggling with Medicare costs, consider asking your State Health Insurance Program (SHIP) for assistance with premiums and other out-of-pocket expenses.
More freedom to see more doctors
Most Medicare Advantage plans are HMOs or PPOs, which prefer or even require you to see in-network providers. Since each insurance company negotiates with medical providers individually, that network may be quite small or localized.
Original Medicare, however, covers visits to any provider who accepts Medicare. That means beneficiaries may have more options by switching to Parts A and B.
A stable plan with few changes year over year
Because private insurance companies offer and manage Medicare Advantage plans, they can change, add, and eliminate plans each year.
Insurers may change their prescription drug coverage. Some plans may even remove your service area from their coverage throughout the year, requiring you to change plans during a Special Enrollment Period.
Original Medicare, on the other hand, generally makes only small, incremental changes to plans each year. If stability is important to you, Original Medicare might be a logical choice.
Ability to pick and choose coverage
Medicare Advantage plans are often ideal for people who want more comprehensive health coverage. But if you have health insurance from an outside source, such as a current or former employer or a retirement benefit, you might want to lower your Medicare costs and coverage.
Many employer-sponsored plans have coverage that’s better than Original Medicare for low or no monthly premiums. Some even cover long-term care. Since Medicare doesn’t cover long-term care, it might make sense to hold on to health insurance that does cover expenses in a long-term care facility, if possible.
While Medicare beneficiaries can use some of these private plans in conjunction with Medicare, doing so would likely result in duplicate coverage—and paying double premiums—if paired with Medicare Advantage.
In this situation, Original Medicare could be a better choice. You can pick and choose which parts of Medicare you need (A, B, and D, or Medigap), and save some cash. With Medicare Advantage plans, coverage is bundled together, not piecemeal.
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What to look for when comparing plans
Considering changing plans, but aren’t sure where to start? You’re not alone. Many Medicare beneficiaries feel overwhelmed by the staggering number of options and requirements. But don’t worry. We have your back.
Let us suggest a Medicare plan to help you create a shortlist of plans that meet your basic criteria. Then, use the following factors to choose an insurer and policy that work for you.
Not all plans are available everywhere. Make sure the plans you’re sorting through cover your service area before you go too far down the rabbit hole. You’ll save yourself a bunch of time.
In-network health care providers
Many MA plans require you to visit in-network providers to be covered for treatment. If the nearest in-network doctors are in another town, you’ll face a tough decision: travel long distances to get care, or shell out the extra cash to go out of network.
Not surprisingly, time and money costs are deal-breakers for lots of people.
Plan quality ratings
Next, find out how plans stack up. Medicare.gov rates plans based on how the plan helps you stay healthy, manage chronic pain, get customer service, and more.
Four- and five-star ratings mean the plan is probably doing something right, while one- and two-star ratings mean the plan is perhaps missing the mark. You can compare quality ratings for Medicare Advantage and prescription drug coverage here.
Many people factor premiums into their decision but don’t pay enough attention to other figures. Health insurance with low premiums often come with substantial out-of-pocket costs in the form of high deductibles, larger copayments, or lower coverage.
If you don’t anticipate significant health issues, a small premium and high deductible could be the way to go. But if you see the doctor a lot, buy a lot of prescriptions, or have a severe medical condition, paying a higher premium for a better plan might save you money down the line.
Look at each plan’s covered services to make sure they include the ones you may need. If you’re shopping for Medicare prescription drug coverage, take a look at each plan’s list of covered drugs. Does it include your medications? How much is the copayment or coinsurance for each?
For many, retiring will bring more opportunities to travel, both locally and internationally. If that’s you, pay close attention to whether your plan will cover you when you visit family out of state or take that trip to Paris you’ve always dreamed of.
What is Medicare Advantage Open Enrollment?
Medicare Advantage is for current Medicare Advantage beneficiaries who want to change plans.
Medicare has several enrollment periods, and each applies to people in different situations. Missing the right period could mean a gap in coverage, late enrollment penalties, or getting stuck in the wrong plan.
Generally, folks should enroll in Medicare during their Initial Enrollment Period, which runs for seven consecutive months when you’re first eligible for Medicare:
- When you turned 65
- After being on disability for 25 months
- If you’ve been diagnosed with end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS)
But let’s say you did enroll in Medicare at the right time. Perhaps you enrolled in Medicare Advantage plan during fall AEP, but you discover the benefits aren’t what you wanted. Or you wanted to change plans during AEP, but you missed the deadline and don’t want to be stuck in the same plan for another year.
The Medicare Advantage Open Enrollment Period is for you.
During OEP, you’re eligible to do one of the following:
Switch from one MA plan to another MA plan
That’s right—even if it’s January 1 and you’ve had your new Medicare Advantage plan for only a single day, you can switch to a different plan.
Switch from Medicare Advantage to Original Medicare
Whether you enrolled in Medicare Advantage in the fall for the first time or are switching back to Original Medicare after many years, you’re eligible to switch back during OEP.
Because transitioning back to Original Medicare means you’ll be dropping the more comprehensive coverage most Medicare Advantage plans provide, you’re eligible to add a Medicare Part D plan too.
When changes take effect
Whether you change to a different Medicare Advantage plan or Original Medicare during OEP, your new benefits go into effect on the first of the following month. In other words, if you change your plan on January 15, your old plan will end, and your new plan will begin on February 1.
What OEP isn’t
If you’ve ever had health insurance through an employer, you probably know that an open enrollment period is your opportunity to enroll in or make changes to your company health plan. If the company offers multiple plans, you can change between them during an open enrollment period, too.
Things work a bit differently with the Medicare Advantage Open Enrollment Period, however.
In a nutshell, Open Enrollment is not for people in the following situations:
People enrolling in Medicare for the first time
These folks have their own, personal enrollment period. It begins three months before the month they become eligible for Medicare and runs for seven consecutive months. If you’re not sure whether you’re eligible, check with Social Security.
Since most people become eligible during their 65th birthday month or 25th month on disability, your Initial Enrollment Period will probably be at a different time of year than OEP. During this period, you’ll need to first enroll in Parts A and B through the Social Security Administration, even if you want to get a Medicare Advantage plan later.
People who have Original Medicare
These folks aren’t eligible for the Medicare Advantage Open Enrollment Period at all. OEP is designed to be a last chance to change your Part C plan if you’re unhappy with it.
If you’re covered by Original Medicare but want to switch to a Medicare Advantage plan, you’ll have to wait until fall Annual Enrollment Period (October 15 through December 7 each year).
People who suddenly lose coverage from another source
If you unexpectedly lose coverage from either your Medicare Advantage plan or another Medicare-approved plan, such as employer-provided health care benefits, you don’t have to wait until OEP to get help.
Suddenly losing coverage is considered a special circumstance, so folks in this situation can ask for an immediate Special Enrollment Period (SEP).
Folks who want to disenroll from Medicare
Beneficiaries who want to leave Medicare completely don’t have to wait for an enrollment period. Instead, they must submit a CMS-1763 form and meet face to face with a CMS representative to go over the consequences of leaving Medicare.
Disenrolling from Medicare completely may mean giving up your Social Security benefits, so going over your options with CMS is a good idea.
What about Medigap?
Medigap (Medicare Supplement) is additional, optional insurance offered by private companies. Medigap plans help Medicare beneficiaries pay for some health care costs Original Medicare doesn’t cover, such as deductibles and copayments. It’s available only to folks who have Original Medicare, not Medicare Advantage.
Many folks switching from Medicare Advantage back to Original Medicare during OEP, however, will consider adding a Medicare Supplement plan at this time. And that’s a bit trickier.
Enrollment in Medigap works a little differently than other parts of Medicare. You can enroll in or change Medigap plans whenever you wish. So far, so good, right?
Unfortunately, there’s an expensive catch. Medigap isn’t regulated the same way the rest of Medicare is.
When to enroll in Medigap
The best time to get a Medigap plan is during Medigap Open Enrollment, which is a six-month period that begins just after you enroll in Original Medicare for the first time. For most folks, that’s just after their Initial Enrollment Period.
During Medigap Open Enrollment, you cannot be denied a Medigap policy because of preexisting conditions. To be clear, Medigap Open Enrollment is different from the Medicare Advantage Open Enrollment (January 1 through March 31) and Medicare Annual Enrollment (October 15 through December 7).
At almost any other time, all bets are off, and you may have to participate in a rigorous underwriting process. Or you may not be accepted into a Medigap plan.
There are a few situations in which you can still get government protections, or Medicare rights, to enroll in Medigap benefits. The most important one for folks using OEP to transition back to Original Medicare is the following rule: if you had a Medigap plan within the past year, your Medicare rights still stand.
For instance, let’s say you had Original Medicare with a Medigap plan in 2018, but you decided to try Medicare Advantage. You enrolled in your Advantage plan during AEP in the fall, but now it’s February, and you’re having second thoughts. So you’re changing back to Original Medicare.
Under Medicare rights, you could get guaranteed acceptance into a Medigap plan. Unfortunately, if it’s been more than a year since you were last enrolled in a Medigap plan, you don’t have those same Medicare rights.
Want more details? Check out our guide to switching from Medicare Advantage to Medigap.
Medicare Advantage Open Enrollment 2019: Are you ready?
Keeping up with changes to Medicare and requirements for switching plans can seem daunting, but you’re not alone. Millions of Americans will be making similar choices this OEP.
Besides, MedicareHealthPlans is here to help. Give us a call, and one of our licensed agents will walk you through the entire process.
Change your Medicare Advantage plan
Call to speak to a licensed agent.855-802-1206